Retainers and retention.

Retention. Retention is the phase of braces after you get your braces off. It is the part of Orthodontics many people hate. In my opinion, it is one of the most important aspects of your treatment. Everyone has a family member, friend or perhaps a personal story about getting braces as a child, and now their teeth are crooked again. Wisdom teeth, jaw growth, lost retainers, extracted teeth, no teeth extracted, genetics, nail biting, tongue habits, crowns, I have heard or seen them all be the blame for crooked teeth after braces. We call this,relapse.

We have been straightening teeth in the Greenwood, SC area for close to 50 years. I am seeing grandchildren of former patients! Whenever I see a former patient, I always ask to take a quick look at their teeth. Sometimes its a bit awkward when you are in the middle of Walmart! Why do I embarrass people like that? I want to know how the treatment has held up for 10, 20, 30 or more years.

It has been my experience that It is harder to keep teeth straight, then to straighten teeth. As you recall from our previous Blog, teeth have a ligaments that connect them to the bone. When these ligaments are stretched, they can keep their memory for a long time. Sometimes forever. This memory may cause the tooth to relapse after braces. Some orthodontists will have the ligaments cut at the end of braces to try and erase the memory. Continuing a habit (thumb sucking, tongue thrusting, nail biting) may create problems after braces. Certain types of genetic problems, like a large space between the front teeth, will keep wanting to return after braces. Without getting into a lot of boring jargon, the mouth is a dynamic place. Things are constantly changing and adapting. Teeth wear, chewing patterns change, teeth are lost,, etc. Teeth are not in concrete, and will move throughout a lifetime, for a variety of reasons.

After reading that, you may think braces can be a waste of time and money. Sometimes they are. When I initially see a patient, I am not only looking at where the teeth are, or where I want them to be, but I am thinking about how I am going to keep them straight. Esthetics, function, and stability are the goals of our treatment plans. Certain cases will need a lot of retention to stay straight, others may not. Some cases will need wisdom teeth or other teeth removed to make room. I try to present a balance of these goals to the patient, and make sure every patient understands retention at the beginning of treatment. In our practice retainers are delivered at the end of treatment, but are thought about and presented at the very beginning. An old Chinese proverb : “If you dont know where you came from, how do you know where you are going?”. Actually not a proverb, I got it from a fortune cookie one time, and it stuck in my head! Seems to fit here.

What kind of retainers do we use? We use a lot of fixed retainers as well as removable retainers. Fixed retainers are tiny pieces of wire that are bonded behind the teeth to prevent relapse. We use them on lower front teeth, and sometimes upper front teeth. These work great, as long as they are kept up with, and the patient doesn’t chew on rocks! I have seen many that have been working for 20 plus years without problems. I have one in my own mouth. No issues for 30 years! I have also seen some that constantly come loose or get lots of tartar build up. Sometimes these need to be removed and the patient must wear a removable retainer to hold the teeth. We see patients for retainer check appointments every 6-12 months after braces are removed, to monitor the retention. Some of our patients come see us every year for many years after treatment…..others I have to chase down in Walmart!

What is the bottom line? Will my teeth move after braces? Unfortunately they will. Maybe a little, maybe a lot. We just can’t accurately predict it. My approach is to develop and discuss retention at the beginning of treatment, and keep a close eye on the teeth after treatment. The retainer check appointments are very important to me, please stay in touch. I hope this answers some questions about retention and why it is so important to maintaining a beautiful smile.